Palermo Tonya M, Srinakarin Kavin, Zhou Chuan, Lalloo Chitra, Dampier Carlton, Zempsky William T, Badawy Sherif M, Bakshi Nitya, Ko Yeon Joo, Nishat Fareha, Stinson Jennifer N
Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States.
Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.
Pain. 2025 Mar 13;166(9):e233-e243. doi: 10.1097/j.pain.0000000000003583.
Pain is the hallmark symptom of sickle cell disease (SCD). By adolescence, 20% of youth with SCD develop chronic SCD pain. Our randomized controlled trial found significant reductions in pain in youth receiving digital cognitive-behavioral therapy (CBT) vs education control. However, little is known about factors that moderate the effects of CBT in adolescents with SCD. This secondary data analysis aims to identify adolescent and family characteristics that moderate treatment effects on pain outcomes in 111 adolescents aged 12 to 18 with SCD (M = 14.9, SD = 1.9, girls = 59%) and their caregivers. Adolescents were randomly assigned to digital CBT (N = 57) or education control (N = 54). Digital CBT included separate content for parents/caregivers (ie, a website to learn problem-solving skills and behavioral and communication strategies) and youths (ie, a smartphone app and website to learn pain management skills). Outcomes were assessed at pretreatment, posttreatment (2 months), and follow-up (6 months). Potential moderators included pretreatment variables (ie, adolescent variables: age, executive functioning, anxiety, depression; parent variables: psychological distress, protective behaviors, family functioning). There was a significant overall effect modification on pain intensity outcomes from pretreatment parent psychological distress (P = 0.012), where CBT appeared more effective among those with elevated parental distress. Differential intervention effects were observed across multiple potential moderator groups, though most of these differences did not reach statistical significance. Our study underscores the importance of family factors in understanding the efficacy of digital CBT for adolescent SCD pain, pointing to the need for future research to optimize CBT through targeted family-focused strategies.
疼痛是镰状细胞病（SCD）的标志性症状。到青春期时，20%的SCD青少年会出现慢性SCD疼痛。我们的随机对照试验发现，与接受教育对照的青少年相比，接受数字认知行为疗法（CBT）的青少年疼痛显著减轻。然而，对于影响CBT对SCD青少年疗效的因素知之甚少。这项二次数据分析旨在确定111名12至18岁SCD青少年（M = 14.9，标准差 = 1.9，女孩占59%）及其照顾者中，调节治疗对疼痛结局影响的青少年和家庭特征。青少年被随机分配到数字CBT组（N = 57）或教育对照组（N = 54）。数字CBT包括针对父母/照顾者的单独内容（即一个学习解决问题技能以及行为和沟通策略的网站）和青少年内容（即一个学习疼痛管理技能的智能手机应用程序和网站）。在治疗前、治疗后（2个月）和随访（6个月）时评估结果。潜在的调节因素包括治疗前变量（即青少年变量：年龄、执行功能、焦虑、抑郁；父母变量：心理困扰、保护行为、家庭功能）。治疗前父母心理困扰对疼痛强度结局有显著的总体效应修正（P = 0.012），在父母困扰程度较高的人群中，CBT似乎更有效。在多个潜在调节因素组中观察到了不同的干预效果，不过这些差异大多未达到统计学显著性。我们的研究强调了家庭因素在理解数字CBT对青少年SCD疼痛疗效方面的重要性，指出未来研究需要通过有针对性的以家庭为重点的策略来优化CBT。
